Standardized Patients (SPs) are lay persons who are employed extensively within health professional education to help teach and assess a range of clinical skills. Individuals trained to take on the physical, historical and emotional aspects of patient stories are integral to the dissemination of collective attitudes, values, and beliefs about what it means to be a competent health professional. As an embodied affective presence literally in front of and often in physical contact with health professionals SPs are a fertile site of knowledge production as well as transformative learning. Their unique contribution is a corollary of both their location as non-clinicians and their pedagogical facility with embodied emotions and affect. SPs in medical education teach about emotion and affect, engage affectively in the presentation of clinical material and as a professionalizing group have developed an educational methodology for facilitating understanding and experience of emotion and affect. In this thesis I examine the field of human simulation and the work of standardized patients (SPs) through critical theoretical perspectives seeking to broaden our understanding of their contributions as a present and future force in health professional education, specifically medical education. Central to my examination is the constitutive role of emotion and affect as they are conceived both within medical education and engaged by standardized patients as media through which different knowledges are produced. My analysis is shaped by poststructuralist feminist writers on emotion, Michel Foucault’s genealogical historical approach, and principally Gilles Deleuze and Felix Guattari’s alternative nomadology as theorized in a thousand plateaus (1987). I intend an alternative reading of the advent of SPs in medical education through a process of mapping rhizomatic networks that include acting, emotion, affect, medicine, and the place of women patients and standardized patients in medical arenas. I have located the current study within an ongoing project of embodied ethical practice and nomadic subjectivity within education specific to human simulation and standardized patients.

Standardized Patients (SPs) are lay persons who are employed extensively within health professional education to help teach and assess a range of clinical skills. Individuals trained to take on the physical, historical and emotional aspects of patient stories are integral to the dissemination of collective attitudes, values, and beliefs about what it means to be a competent health professional. As an embodied affective presence literally in front of and often in physical contact with health professionals SPs are a fertile site of knowledge production as well as transformative learning. Their unique contribution is a corollary of both their location as non-clinicians and their pedagogical facility with embodied emotions and affect. SPs in medical education teach about emotion and affect, engage affectively in the presentation of clinical material and as a professionalizing group have developed an educational methodology for facilitating understanding and experience of emotion and affect. In this thesis I examine the field of human simulation and the work of standardized patients (SPs) through critical theoretical perspectives seeking to broaden our understanding of their contributions as a present and future force in health professional education, specifically medical education. Central to my examination is the constitutive role of emotion and affect as they are conceived both within medical education and engaged by standardized patients as media through which different knowledges are produced. My analysis is shaped by poststructuralist feminist writers on emotion, Michel Foucault’s genealogical historical approach, and principally Gilles Deleuze and Felix Guattari’s alternative nomadology as theorized in a thousand plateaus (1987). I intend an alternative reading of the advent of SPs in medical education through a process of mapping rhizomatic networks that include acting, emotion, affect, medicine, and the place of women patients and standardized patients in medical arenas. I have located the current study within an ongoing project of embodied ethical practice and nomadic subjectivity within education specific to human simulation and standardized patients.

Thesis (M.A.)--Indiana University, 2007. / Title from screen (viewed on January 9, 2008). Department of Communication Studies, Indiana University-Purdue University Indianapolis (IUPUI). Advisor(s): Stuart M. Schrader, Kim D. White-Mills, Elizabeth M. Goering, Jane E. Schultz. Includes vitae. Includes bibliographical references (leaves 85-94).

Empathetic communication enhances the nurse-patient relationship and improves patient outcomes and needs to be taught and evaluated during simulated clinical experiences. Experience in healthcare education has shown students' empathy levels decrease over time. The purpose of this quasi-experimental pretest posttest, study was to compare nursing students' empathy levels, self-confidence, and satisfaction with simulation between the use of the high-fidelity manikin simulator (HFMS) and a standardized patient (SP) used during their simulated clinical experience. Kolb's experiential learning theory was used to guide the study through the four phases specific to simulation and learning. Convenience sampling was used to recruit 135 nursing students in the pre-simulation survey; 123 participants completed the post-simulation survey with 64 in the control group (HFMS) and 59 in the experimental group (SP). Data were analyzed using an independent t-test to determine if there were any mean differences between the HFMS and SP groups in terms of empathy, satisfaction, and self-confidence. Empathy was measured using the Jefferson Scale of Empathy-Health Professions Student and the NLN's Satisfaction and Self-Confidence Scales. Results revealed there were no significant difference in students' empathy levels, self-confidence, and satisfaction. Positive social change through prioritizing nursing students' empathetic communication in patient care may be enhanced in the simulated clinical environment with various approaches. Recommendations for future research are to determine what interventions best develop nursing students' empathy, satisfaction, and self-confidence in patient care .

Background: Prelicensure nursing programs prepare generalists with essential knowledge, skills, and attitudes to practice in complex health care environments. Nurse educators determine which teaching strategies will best prepare the nurse generalist. Purpose: The purpose of this study was to determine the effectiveness of a teaching plan that combined the strategies of pretest/posttest, classroom activities, and a problem-based learning activity: a clinical immersion experience. The skill of "teach-back" was taught and evaluated. Theoretical framework: Two theories guided the teaching plan for this research. Adult learning theory (Knowles, 1975, 1980, 2012) addressed how and why adults learn, and social cognitive theory (Bandura, 1977, 1986) described teaching strategies that assisted the adult learner to gain knowledge. Methods: A non-experimental design divided consenting participants were into intervention (n = 21) and control groups (n = 11). The Health Literacy Knowledge and Experience Survey (Cormier, 2006) was used to pretest/posttest for attainment of knowledge related to teach-back. The Communication Assessment Tool (Makoul, Krupat, & Chang, 2007) was used by standardized patients to evaluate the participants' ability to perform a teach-back. Results: The results of this study provided evidence that posttest scores improved for both intervention and control groups (n = 32). Twenty-seven participants performed a teach-back with evaluation. The results did not indicate a significant difference between groups in performing the skill of teach-back. Conclusion: There was little difference in posttest scores for groups and participants' ability to perform a teach-back, indicating that both groups gained knowledge and skill from the teaching strategies.

Indiana University-Purdue University Indianapolis (IUPUI) / In relationship-centered care, the relationship formed between physician and patient is critical to the creation of positive patient outcomes and patient satisfaction (Inui, 1996; Laine & Davidoff, 1996; Tresolini, 1994). Medical educators have increasingly utilized Objective Structured Clinical Examinations (OSCEs) to assess medical students’ abilities to utilize a relationship-centered approach in clinical interviewing. OSCEs, however, have recently come under scrutiny as critics contend that the overly scripted and standardized nature of the OSCE may not accurately reflect how medical students build and maintain relationships with patients. Although some studies have looked at how standardized patients help teach medical students interviewing skills, few studies have looked specifically at how the structured nature of the OSCE may influence relationship-building between standardized patients and medical students. Therefore, this study asks the question “How is relationship-centered care negotiated between standardized patients and medical students during a summative diagnostic OSCE?” Using an ethnographic methodology (Bochner & Ellis, 1996), data consists of an ethnographic field journal, transcripts of semi-structured interviews with SPs and medical students, and transcripts of headache and chronic cough videotaped scenarios. Using grounded theory (Strauss & Corbin, 1990, 1998), a back-and-forth thematic analysis was conducted in discovering the saturation of conceptual categories, linking relationships, and in critically comparing interpretive categorical concepts with relevant literature (Josselson & Leeblich, 1999). Findings suggest that standardized patients and medical students hold differing expectations for 1) diagnostic information gathering and 2) making personal connections upon entering a diagnostic summative OSCE. SPs “open up” both verbally and nonverbally when medical students “go beyond the checklist” by asking discrete diagnostic questions and when overtly trying to connect emotionally. Fourth year medical students, however, expect SPs to “open-up” during what they experience as a rushed, time-constrained, and overly structured “gaming” exercise which contradicts their own clinical experiences in being more improvisational during empathetic rapport building. Differences between SPs and medical students’ expectations and communication practices influence how they perform during summative diagnostic OSCEs. Findings may suggest the re-introduction of more relationship-focused OSCEs which positions SPs as proactive patients who reflexively co-teach students about the importance of making personal connections.

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The methods used to train actors can be modified to train standardized patients to simulate patient encounters with medical students. With some background in standardized patients and simulation, a member of Theatre Department can start a standardized patient program at their own institution. This is based on the pilot year of the VCU Standardized Patient Program which began in June, 2011.

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